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Hemodynamic effects of oxygen therapy in patients with acute exacerbations of chronic obstructive pulmonary disease
A Esteban1, E Cerda, M A De La Cal
1Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Madrid, Spain.
Abstract:
The effects of oxygen therapy in patients with stable COPD have been previously reported; however, the hemodynamic changes induced by oxygen therapy in patients during acute exacerbations of COPD are less well known. To investigate the hemodynamic effects of controlled oxygen therapy in patients with acute exacerbations of COPD shortly after arriving at the hospital, we studied 15 consecutive patients who came to the emergency room with acutely decompensated COPD that did not require mechanical ventilation. Patients were monitored with a pulmonary artery catheter and a radial artery catheter. Oxygen uptake was calculated by the modified Fick equation. Arterial and venous blood gas levels and hemodynamic parameters were measured while breathing room air (baseline) and after 30 min on oxygen therapy via face mask. Measurements were repeated after 24 and 48 h. The fractional concentration of oxygen in the inspired gas (FIO2) administered was adjusted to keep the PaO2 above 55 mm Hg. All patients had a PaO2 below 45 mm Hg at the beginning of the study. After 30 min of oxygen therapy, there was a significant (p < 0.05) increase in arterial oxygen saturation (from 62 +/- 16 to 87 +/- 9 percent), mixed-venous oxygen pressure (from 25 +/- 5 to 43 +/- 11 mm Hg), and oxygen delivery (from 11.1 +/- 3.7 to 19.3 +/- 8.9 ml/kg.min). Oxygen uptake did not change significantly (from 4.1 +/- 1.2 to 4.3 +/- 1.6 ml/kg.min). The oxygen extraction ratio decreased from 37.5 +/- 10.1 to 25.3 +/- 9.6 percent. These changes were maintained during the following 48 h. There were no significant changes in cardiac output and systemic vascular resistance. A trend toward lower values of pulmonary vascular resistance did not reach statistical significance. We conclude that oxygen therapy in patients with acute exacerbations of COPD that do not require mechanical ventilation increases oxygen delivery without changes in cardiac output or oxygen uptake.
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